Dataset Information

Early lactate measurement is associated with better outcomes in septic patients with an elevated serum lactate level.

ABSTRACT:

Background

The optimal timing of lactate measurement for septic patients in the intensive care unit (ICU) remains controversial, and whether initiating and repeating the lactate measurement earlier could make a difference for septic patients with an elevated lactate level remains unexplored.

Methods

This was a retrospective observational study that included septic patients with an initial lactate level >?2.0?mmol/L after ICU admission, and all data were extracted from the Medical Information Mart for Intensive Care III (MIMIC-III) database. The main exposure of interest was the early lactate measurement, which was defined as an initial lactate level measurement within 1?h after ICU admission. The primary outcome was 28-day mortality.

Results

A total of 2642 eligible subjects were enrolled, including 738 patients who had initial lactate measurements completed within 1?h (EL group) and 1904 patients who had initial lactate measurements completed more than 1?h after ICU admission (LL group). A significant beneficial effect of early lactate measurement in terms of 28-day mortality was observed: the adjusted odds ratio (OR) was 0.69 (95% CI 0.55-0.87; p?=?0.001), and the mediation effect of the time to initial vasopressor administration was significant (average causal mediation effect (ACME) -?0.018; 95% CI -?0.005 approximately to -?0.036; p?ConclusionsEarly lactate measurement is associated with a lower risk-adjusted 28-day mortality rate in septic patients with lactate levels >?2.0?mmol/L. A shorter time to the initial vasopressor administration may contribute to this relationship. Repeating the lactate measurement within 3?h after the initial measurement is appropriate for patients whose lactate levels were measured within 1?h of admission.

SUBMITTER: Chen H

PROVIDER: S-EPMC6849274 | biostudies-literature | 2019 Nov

REPOSITORIES: biostudies-literature

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Early lactate measurement is associated with better outcomes in septic patients with an elevated serum lactate level.

Chen Hui H Zhao Chenyan C Wei Yao Y Jin Jun J

Critical care (London, England) 20191111 1

<h4>Background</h4>The optimal timing of lactate measurement for septic patients in the intensive care unit (ICU) remains controversial, and whether initiating and repeating the lactate measurement earlier could make a difference for septic patients with an elevated lactate level remains unexplored.<h4>Methods</h4>This was a retrospective observational study that included septic patients with an initial lactate level > 2.0 mmol/L after ICU admission, and all data were extracted from the Medical ...[more]

PMID: 31711512

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Project description:ObjectivesMottling score is estimated from 0-5 according to mottling over the knee and described as clinical evaluation of tissue perfusion. This score was developed with ancient definitions of sepsis without lactate level, a major prognostic parameter when superior to 2 mmol/L. This study describes mottling incidence and mottling score in septic shock patients according to lactate level.Materials and methodsWe reanalyzed our prospective study in a French tertiary hospital in the intensive care unit (ICU) which studied mottling score and thermography correlation. Patients admitted to septic shock diagnosis and requiring vasoactive drugs were included. We recorded hemodynamic variables, mottling score, and lactate. Data collection was realized at ICU admission (H0) and after six hours (H6).ResultsForty-three patients were included. Mean age was 67 (±4), mean sequential organ failure assessment (SOFA) score was 11 (8-12), and SAPS II 58 ±20. Mortality rate at day 28 was 30%. Among patients with lactate ≥2 mmol/L, mottling was more prevalent in 82.6% vs 47.4% (p value = 0.016), and at H6 mottling score was higher (p value = 0.009). Although, mottling incidence was not different between dead (85%) and survivors (81%; p value = 0.795).ConclusionA new sepsis definition implies a new epidemiology in mottling according to lactate threshold. Patients with lactate ≥2 mmol/L presented a higher incidence and score of mottling. However, mortality was not influenced by mottling in this study.Clinical significanceArterial lactate is a major prognostic parameter when superior to 2 mmol/L.A new definition of sepsis was published in 2016 with a new paradigm and epidemiology of septic shockPatients with lactate ≥2 mmol/L presented a higher incidence and score of mottling.Mottling score is a clinical sign of microcirculatory alteration, related to lactate level in septic shock.How to cite this articleFerraris A, Bouisse C, Thiollière F, Piriou V, Allaouchiche B. Mottling Incidence and Mottling Score According to Arterial Lactate Level in Septic Shock Patients. Indian J Crit Care Med 2020;24(8):672-676.

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Dataset Information

Early lactate measurement is associated with better outcomes in septic patients with an elevated serum lactate level.

Background

Methods

Results

Publications

Early lactate measurement is associated with better outcomes in septic patients with an elevated serum lactate level.

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